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Problems and Purpose

The problem was how to allocate limited supplies of vaccine during a severe pandemic when people would be at increased risk of death or hospitalization, yet vaccine supplies would be limited and there would not be enough vaccine for everyone. The federal government wished to issue national guidance to state and local health departments on how to proceed. To this end, the public made a specific contribution by coming together, learning about pandemic influenza, engaging in give and take discussions with other persons with different views and perspectives, identifying their values around this tough choice, weighing the tradeoffs, and reaching agreement on which persons were the most important to vaccinate first - those categories of persons most important to society.

History

The government agency faced a difficult values dilemma about who first to vaccinate in a pandemic. A pilot project on Influenza vaccination was scheduled for 2005. It was determined that the best course of action would be to call on the public to make tough choices based on their values, group deliberation, and impartial information. It was part of an ongoing initiative to introduce more participatory approaches to public health decision making called “Putting the Public in Public Health”

Originating Entities and Funding

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Participant Recruitment and Selection

Target groups were the general public or citizens-at-large plus representatives of key stakeholder organizations coming from all of the key sectors with recognized interests on this topic. Project organizers sought representation from all age, sex, and major ethnic groups in the US. All evaluations for the project concluded that "good diversity" was acheived in the type of participants who came.

According to the final report:

Two to three representatives from the organized stakeholder public were chosen from approximately ten major sectors likely to be affected by the control measures (e.g. education sector), to form a 50 member national level panel. To outreach to the larger public, a sample of approximately 260 citizens from the general public representative by age, race, and sex were recruited from each of the four principal geographic regions of the United States and included citizens in Seattle, Washington; Syracuse, New York; Lincoln, Nebraska; and Atlanta, Georgia. https://goo.gl/tgGNDf

Methods and Tools Used

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Deliberation, Decisions, and Public Interaction

According to Final Reports, the project contained the following phases: Pilot phase (2005) and Phase II "Public Engagement Project on Community Control Measures for Pandemic Influenza (2007).

Influence, Outcomes, and Effects

The public engagement was successful. The government agency faced a difficult values dilemma about who first to vaccinate in a pandemic. The public made a specific contribution by coming together, learning about pandemic influenza, engaging in give and take discussions with other persons with different views and perspectives, identifying their values around this tough choice, weighing the tradeoffs, and reaching agreement on which persons were the most important to vaccinate first - those categories of persons most important to society. Creating this group product or recommendation provided "proof of principle" to these government agencies that people with diverse views could better inform public policy making on difficult values-laden policy issues. This was a clear and specific contribution to the decision making process.

According to the Secretary of Health and Human Services Mike Leavitt speaking in 2008 when the document was released, "this guidance is the result of a deliberative democratic process. All interested parties took part in the dialogue; we are confident that this document represents the best of shared responsibility and decision-making."

The success of the Pilot Project lead to the use of public engagement for the creation of a national vaccine strategy in 2009 under the name "Citizen Choices on the National Vaccine Plan".

Anlysis and Lessons Learned

Strengthening of participants' democratic capacities was a key goal of the project. This project supported broader goals by introducing an innovative method of engaging both the citizen and stakeholder publics, showing that it works to create a productive outcome among people with different views, and showing that the public input can actually be used to shape national policy. The public's "fingerprints" were on the final national guidance document.